title: Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis of all published studies of sentinel lymph node (SLN) biopsy for staging patients with melanoma.
  
  
  METHODS
  Published literature in all languages between 1990 and 2009 was critically appraised. Primary outcomes evaluated included the proportion successfully mapped (PSM) and test performance including false-negative rate (FNR), post-test probability negative (PTPN), and positive predictive value in the same nodal basin recurrence.
  
  
  RESULTS
  A total of 71 studies including 25,240 patients met full eligibility criteria. The average PSM was 98.1% (95% CI, 97.3% to 98.6%) and increased with the year of publication, female sex, ulceration, age, and the quality score of the studies. The FNR ranged from 0.0% to 34.0%, averaging 12.5% overall (95% CI, 11% to 14.2%). FNR increased with the length of follow-up (P = .002) but decreased with greater PSM (P = .001). PTPN averaged 3.4% (95% CI, 3.0% to 3.8%), which also increased in studies with longer follow-up, younger age, female sex, deeper Breslow thickness, and with tumor ulceration while decreasing with greater PSM (P < .001). Approximately 20% of the patients with a positive SLN had additional lymph nodes in the complete lymph node dissection and 7.5% of the patients with positive SLN developed recurrence in the same nodal basin which was greater in studies that also reported higher FNR (P = .01).
  
  
  CONCLUSIONS
  The estimated risk of nodal recurrence after a negative SLN biopsy was ≤ 5% supporting the use of this technology for staging patients with melanoma.
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Matias E
authors.initials: ME
authors.lastname: Valsecchi
authors.forename: Damian
authors.initials: D
authors.lastname: Silbermins
authors.forename: Nicole
authors.initials: N
authors.lastname: de Rosa
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy; D013194:Staining and Labeling